Multi-Specialty Physician Practice Finds Value in Care Coordinators

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Kenneth-Croen-thumbScarsdale Medical Group is a medium-sized, multi-specialty physician practice with three locations in New York’s Westchester County and the Hudson Valley area. The practice offers a wide range of specialties including cardiology, endocrinology, pulmonary, infectious diseases, rheumatology, gastroenterology, nephrology, geriatrics, dermatology, neurology, gynecology, podiatry, nutrition, and mind-body medicine.

Using technology and care coordinators for seamless care

Scarsdale Medical Group has been well ahead of the healthcare-reform curve, having used electronic health records for 10 years. A patient portal allows physicians to generate reports for patients and send data instantaneously. The group is also a Level 3 Patient-Centered Medical Home.

“We keep constant pressure on ourselves to bring innovative ideas to our practice,” said Dr. Kenneth Croen, managing partner of the practice.

Using care coordinators is one strategy Croen believes is important to improving healthcare. Many patients get lost in the system after a hospital visit. Scarsdale uses coordinators to help bridge that gap. The practice has three care coordinators currently and would like to add more, but it is a service that is tough to afford.

One care coordinator acts as a hospital liaison who visits the patients on admission and during their stay. She also reviews discharge plans and medications with patients. Additionally, the coordinator contacts the office and updates the out-patient record to allow for a more continuous care experience for patients.

“The biggest hole in the healthcare system is the transition from one location to another,” Croen said. “When our data comes in, I anticipate it will show that our coordinator process has led to a decrease in readmissions.”

To fill in gaps where there aren’t enough coordinators, the practice’s physicians often work long after their office hours have ended, making phone calls and answering messages on the patient portal. For this reason, Croen said he hopes to be able to hire more coordinators in the future.

Growing the practice and specialties

Scarsdale began as a two-physician practice, but its recent growth has been impressive. Over the past 2 years, the group went from 22 physicians to 34 and is still expanding.

“We offer an attractive model for practice,” Croen said. “Many physicians are realizing that it’s not profitable to stay autonomous and are hunting for a place to call their own.”

Scarsdale is selective about the physicians it recruits, but the doctors have the opportunity to be involved in decision-making for the group. The group is mostly overseen by a series of committees on quality improvement, personnel, marketing, recruiting, lab, and care coordination, as well as the Management Committee.

Giving new physicians more space to practice, Scarsdale is opening an outpatient surgical suite for podiatry, gynecologic surgery, endoscopies and colonoscopies, and other outpatient procedures.

Scarsdale is surrounded by several large medical practices, including some linked to New York City medical centers. But Croen is confident in the quality of care at Scarsdale, care that is provided at lower fees than the larger medical practices.

During a contract renegotiation, Scarsdale presented data to three insurance companies related to managing patients with diabetes. Compared with data from the New York Insurance Commission, Scarsdale far outperformed both the state and national averages, mainly because the group has more than 2,000 patients with diabetes and has a comprehensive program with four endocrinologists, three nutritionists, one diabetes educator, and a rigorous and effective weight-loss program.

Moving forward in a changing environment

The last several years have created an air of uncertainty around the healthcare industry, and Scarsdale is looking at the best ways to position itself in this changing environment.

Croen said Scarsdale has been offered opportunities to join various institutions, including local hospitals, but has chosen not to.

“We like our independence,” he said. “I think we can do well on our own.”

Croen is also resistant to Accountable Care Organizations, which, to be successful, need to keep patients within a network of providers. In addition, the providers are incentivized to maintain quality but at a lower cost. However, Westchester County is a fairly wealthy area, and many people receive care wherever they choose, regardless of networks.

“Patients are not a part of savings in an ACO, so there is no incentive for them to participate,” he said. “Doctors should not look for ways to save money on patient care without engaging the patient in that conversation. Mistakes will be made, and we don’t want to go down that path.”

Croen said a better path would include transparency of cost and quality, allowing patients to find high-value healthcare. Patients with skin in the game will have an incentive to be healthy. Most patients are not aware of the large discrepancies present in fees paid for the same procedures at different facilities.

“When people are unaware and unconcerned about costs of care, they go where they please,” he said. “We can lower healthcare costs by letting people have access to fees before they get care and then be responsible for a portion of the cost of their care.”

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